Ah, what to eat at night.

The perplexity of choosing snacks which aren’t going to add to the methane problem.

And it has to be tasty because snack time is the best bit of the shift, or at least a close second to pool births.

We know that people who do shifts, especially nights, are more at risk of all kinds of metabolic problems. Everything from extra gas because your tummy’s working odd hours, to obesity and type 2 diabetes to ulcers*. Thanks, vocational career!

But the evidence suggests some of this risk is because of quality of diet and we actually have control over this bit.

There will be times where everything on shift is conspiring to get you to make unhealthy food choices.

But if you’re like me, junk makes you feel worse, especially if it’s part of a pattern of eating badly. As a long distance runner, I can feel what a few weeks of sugar does to my body and it’s not pretty.

Shifts can also make it harder to make healthy food at home. If you’ve have three 12 hour nights, seen six babies born, been there for a cat one section and now don’t have the energy to meet up with mates as planned, it’s easy to stay on the sofa, order a takeout and make sure they put in some of those soft bake cookies too.

We all know that midwifery is way more demanding and important than running, so, let’s fuel right.

Obviously everyone is different and these specific suggestions won’t work for everyone. But take what works and adapt, and if you find something helpful, awesome!

5 ideas for shift work meals you prepare the night before/have at home:

Leftovers, cook with lots of veg and you’re eating healthy the next day with no effort (pasta tomato bake, curry, stew etc.)

Baked potatoes: hear me out. Cold baked potatoes are FABULOUS. Cook them by rubbing them with a bit of olive oil and salt and bake them in the oven. Then have them cold the next day with some cream cheese from a tub and some cherry tomatoes. So easy to prepare. I used to do loads at once and freeze them

I’m into chickpea cous cous at the moment. Chickpea couscous: just add stock, I add tinned tomatoes, herbs (dry) and garlic granules (dry) and top with some grated cheese. Better for you than wheat couscous apparently and again, very quick

5 ideas on what to eat at night:

Porridge, fill yourself up with good carbs – blueberries are supposed to be great at keeping blood sugars steady, use oat milk instead of dairy for less..y'know

Take a homemade smoothie – you can experiment with adding nut butter and coconut oil, which have good fats which will keep you full and healthy. In my experience, the fats seem to help with the gas issue too because we all know smoothies can produce nuclear weapon level sound effects

There’s nothing wrong with having a big cup of fancy coffee before a shift, it’s a treat and you are working against your body clock. Sprinkle with cinnamon, again this is supposed to keep your blood sugars level. Also...it can help you go to the loo, again good for the gas issue

Make yourself a Really Amazing Sandwich – nice seedy bread, cucumbers and spinach, tuna or another protein. Maybe not hummus on the night unless it doesn’t impact you!

Try some very dark chocolate. The magnesium will help you sleep later and the caffeine will keep you up on shift

Ideas for healthy ‘emergency rations’ to have in your bag:

(These are for those times when you have to grab something while doing your notes).

Peanut butter sachets. Nut butter is great natural fuel which doesn't have sugar in, these can be expensive but as emergency food they're my go to thing

Those fruit and nut power ball or flapjack things – or make your own (I just mash ripe bananas with a little water, coconut oil and a few whizzed up dates + the oats to form a sticky mass – in the oven in a tin @ 180 degrees for 20 minutes or so – cheap) – I would have a few of these in your uniform pocket if at all possible!

Electrolytes for your water bottle, these help prevent headaches

My other busy midwife health hack is to keep fresh sauerkraut in my fridge at home. Please give it another chance if you’ve tried it and hated it, the raw food company sauerkraut is absolutely delicious, like a raw, mild crunchy cabbage salad.

The ingredients are just salt and cabbage but it's full of healthy bacteria. There’s limited research out there but it’s been a health food for about 2000 years that to me this is basically a longitudinal research study.

I add this to the side of pretty much every meal, though I wouldn’t take it to work, way too stinky. And my boyfriend loves Kimchi but we won’t go there just now...

Over time, your gut health should get better and it’ll help with bloating on night shifts.

I’m not saying I don’t fall off the wagon from time to time (god, I discovered sesame snaps about a month ago, sometimes you can’t help it) but a healthy diet is important.

I mean, everything in midwifery is important but the health of the workforce is the foundation on which care runs. If you don’t take your health seriously, all the midwifery skills you build up over a career can disappear because your main tool – your body – can’t do it.

Delicious and healthy food that you prepare for yourself = good care for the women.

THANK YOU for doing shift work or being there for women across the weird hours needed.

I’d love to hear from you:

What are your go to recipes for eating around shifts, oncall and nights?

Have you noticed you have more energy when you’re eating right?

If you’re not currently paying too much attention to your diet and you’re feeling bad about it, forgive yourself immediately, you have a really challenging job. But what’s one thing you can do to change things?

Leave me a comment below and don’t forget to share this with anyone midwifery related who might find it helpful.

All my best, Ellie x

P.S. Something important I need to tell you: I have huge problems doing nights. This isn’t something I’m ready to talk about on my blog. As the writer Elizabeth Gilbert once wrote ‘this is a story I’m living right now rather than one I’m telling’ so I hope you understand if I don’t go into more detail. But I didn’t feel right not telling you any of this either, considering I'm recommending some ideas. These really are the foods I used for nights and it did help but it turned out I had bigger concerns.

I run a big midwifery Facebook group and one of the questions coming up a lot recently is:

‘Is 37 weeks pregnant actually term?’

Follow up questions include:

Is a Mum allowed to use a birth centre if she’s exactly 37 weeks pregnant? What about if she’s one day before that?

Does a baby at 36+6 need extra observations and heel prick blood glucose levels doing? What about if the heel pricks stresses them out and interferes with breastfeeding? Could we just pretend they’re 37 weeks since it’s so close?

How important is this concept of 'term' anyway?

I can easily get stuck on this kind of question. This is my typical thought process:

1. SAFETY! Safety first, I have a responsibility to offer the safest care I can, and who am I to question guidelines, I’m just one fairly junior midwife

2. Lots of excellent midwives I know are fans of cut off points, so there must be good evidence for this

3. But when I look up the evidence or read researcher’s blogs words like ‘low quality’ and ‘weak’ start to pop up...are we making decisions based on culture again?

4. Conversations about due dates, induction of labour, and whether babies born at 37 weeks are more at risk are HARD!

I bet you’ve come across similar problems?

You might know about Dr Sara Wickham, I have a burning desire to lock myself in my room and binge read her blog fairly often. She’s a researcher and independent midwife.

She and other researchers have a lot to say on the topic of due dates and the concept of being 'term'.

For instance, the 280 days of pregnancy we use to estimate the ideal length of pregnancy appears to come from something called Naegele’s rule, which we started using in the 1800s. There’s not much new evidence to back it up.

(Naegele was a German Obstetrician or a ‘dirty old man who names things after himself’ to quote one of my old midwifery lecturers, smashing the patriarchy one physiology lecture at a time...).

Only 4% of babies will arrive on their due date. Also, there’s evidence to suggest that dating scans are only as accurate as last period dates. They're not as precise as we sometimes like to think.

Also, what about genetics, ethnicity and even nutrition? Wouldn’t it be weird if these things had no impact on a woman’s ideal length of pregnancy?

All in all, due dates are questionable.

The other thing is, we’re not really sure what starts labour. It’s a synchronised swim of hormones and physiology. It's not a factory process which notices a finished baby and then ships it at the correct date.

How do we know if a woman’s gone into labour for the correct physiological reasons or if something else has started it? We don’t often have clear answers. One baby could be completely ready at 37 weeks and another might be displaying breathing problems associated with prematurity.

We also don’t know why! Is it because women have varying length pregnancies or because we have due dates wrong?!

What we come back to is:

What even is a full term pregnancy?

I’ve come across some evidence from the American College of Obstetricians and Gynaecologists which suggests that the idea of ‘term’ simply looks at the evidence on how babies get on when they’re born. On average, at 40 weeks, babies have least respiratory and other problems, though anything from 37-40 weeks looks pretty good too.

But newer evidence suggests babies born between 39-41 weeks do ever so slightly better. This means in the USA, 37-38 weeks is now considered ‘early term’.

But these studies aren’t perfect, the concept of a due date is just our best educated guess.

So is 37 weeks actually term?

If we going to go along with the concept of a term pregnancy, most guidelines, including those from the UK, say yes. America has recently renamed 37-38 weeks ‘early term’.

But as with all these things, it’s a line in the sand based on all available evidence.

Mother Nature didn’t leave us with a rule book saying ‘pregnancies will end between 37 and 42 weeks and if this doesn’t happen medical science will need to intervene’. It’s all just on a scale.

Having good observational midwifery skills and knowing the things that babies need like breastfeeding, skin to skin, rooming in with Mum, etc., are all good ways of supporting a baby who may or may not be a little early.

I’ll be making it my mission to to get to know every Mum and baby as an individual (as far as possible in busy practice!), as this is the best way of picking up on issues.

Now I’d love to hear from you:

Have you had experience with babies born around 37 weeks? Any stories you can share to teach us?

Is questioning the evidence and not having absolute answers about due dates outside your comfort zone? If so, what’s one action you can take to better communicate evidence to women?

Hope you found this as interesting to read as I did to write!

All my best, Ellie xx

p.s. Comments welcome, please put in as much detail as possible. You never know, what you add might prompt the breakthrough that another student or midwife needs to support a woman 🙂

If someone asked you what the new NMC education standards mean for midwives training in 2019 and beyond, would you know how to answer?

Or would you think ‘I should know this, I care!’

Maybe you’ve had a look at the new Nursing and Midwifery Council guidelines on education and gone ‘ack, complicated, what?’

When you see 19 separate guidelines on practice supervision in corporate speak on the NMC website, it’s easy to get demoralised.

But it’s actually pretty straightforward.

In this post I’ll set out what you need to know in easy terms and with some of my informed opinions sprinkled in, ‘cos it’s my blog : )

You can also watch the video if that's easier.

In 2017, the NMC ran a consultation on education standards that midwives could add their opinions to. There have been panels and independent evaluation groups at the NMC looking at changing and improving education for midwifery since then.

The NMC have said several times that new education standards for midwives are needed because the world is changing, women’s lives are different and midwives have a more demanding role and skill set than ever before. Events like those at Morecambe Bay will likely have been a reason for the new standards too.

These standards will be rolled out from winter 2019.

The changes that stood out to me are as follows:

Care simulation hours will no longer be capped. Unis will be able to have their students spend more time in skills labs if this is what they feel is best. Students tend to value these sessions, so as long as simulated practice doesn’t outweigh real practice, this sounds like a good thing to me.

The NMC will also be adopting prescribing guidelines from the Royal Pharmaceutical Society, which sounds fine. Midwives have stringent rules around prescribing anyway since unlike nurses, they can prescribe pretty much from qualification, so I can’t imagine this will be too different. Interestingly nurses will also be able to prescribe as soon as they’re qualified too when previously they had to wait three years to apply.

But the most important change for me is that clinical mentors will no longer be a thing.

In the past, student midwives has ‘personal tutors’ doing the academic side of things and ‘sign off mentors’ who they had to work with 40% of the time in clinical practice.

Under the new standards instead of these there will now be:

Academic Assessors

and

Practice Assessors

These two staff members will collaborate on how students are doing and together recommend that students should progress to the next stage of the course (or not) .

This is an interesting change because students don’t have to work with one key mentor as much.

Instead they can work with ‘Practice Supervisors’ who can be any staff member regulated by the NMC. ‘Practice Supervisors’ might be newly qualified midwives, paediatric nurses, basically anyone with good skills to teach students. The new standards mean anyone regulated can muck in with teaching.

Practice Assessors will collate feedback from Practice Supervisors.

It’s my conjecture that students will get to work with more people and there will be more flexibility about teaching in placements. The same standards or higher will apply and unis and placements will be able to organise themselves as they see fit.

This might mean more student midwives can be trained, which is what the government wants and the country needs.

It also might mean nothing changes in some places. Students will continue to primarily work with sign off mentors just under the new name of ‘practice assessors’.

I’m very capable of criticising the NMC when necessary (see my series of posts from when Independent Midwives weren’t allowed to practice), but for me, in terms of the new education standards, it looks like there’s potential for students to get an amazing level of education.

Of course, this is all up to universities and trusts.

It also means as a newly qualified midwife you may end up having a student with you much sooner.

This could be a problem, we don’t want the blind leading the blind. But the newly qualified midwives I’ve met are up to date with the research and have a ‘third eye’ of hyper vigilance in terms of accountability and asking for help. They may also get how to teach students midwifery skills since they’ve had recent experience of being students themselves.

The only issue is continuity. With ‘Better Births’ being implemented around the country to achieve continuity for women, with all the benefits and satisfaction that seeing one midwife provides, I can understand why many are wary of taking continuity of mentorship away from students.

But I think there’s always been a need for students to find their own mentors to help nurture them through their career.

The midwives who formed me most didn’t necessarily mentor me, I was won over watching their practice or reading their books or online comments. I made contact at conferences or found out about their work through groups like the Association of Radical Midwives.

Often it was all to do with the emotional wellbeing of women and how they made them feel, though of course epic clinical skills are vital to underpin this.

It’s also this group of informal mentors that I learnt midwifery intuition from : )

Under the new NMC education guidelines, it might be even more important to seek this kind of mentorship out for yourself.

1. How do you think the new NMC education standards will impact you?2. Do you have a midwifery role model? How did you meet them or learn from them – how would you suggest a student or newly qualified midwife find such a person?

Would you know what to say to a woman with four or five, or even ten or more children?

Finding the courage to speak up about something isn’t easy. Today’s post is from Rosie Brown, mum of five, who's expecting number six. She's an aspiring midwife and her open letter to women and midwives is about having a large family and some of the comments she’s received from medical professionals.

'Dear Ladies and Gents,

Would you take a moment to listen? I promise you will be a blessing to others like me.

I'm an aspiring midwife and now I guess I am a 'Grand Multigravida' too.

I've had something on my weighing on my heart for a while and it's been stirred by the opening scenes of One Born Every Minute series 11.

There's a lady expecting her 6th baby and the midwife says something along the lines of "haven't you worked out what's causing it?"

Future and current midwives. We might laugh it off and make a funny come back like we don't care, but do you know how exhausting this is?

Every day, every week when we are out with our children, here is what we encounter, from complete strangers.

"Don't you know what causes that?"

"Don't you own a TV?"

"Aren't you a glutton for punishment."

"Wow, how old are you?"

"Do they all have the same dad ?"

"Don't you know what birth control is?"

"Are you done?'

And then to have your midwife or health care assistant do the same when you are vulnerable can be overwhelming.

We sit on a ward listening to midwives go to other couples with 1 or 2, even 3 kids, and there are sweet and reassuring comments.

And then it's our turn.

For whatever reason, parents with big families don't get reassured.

Last week I was in A&E and a health care assistant was taking me for a test, and do you know how relieved I was when he said "Oh how lovely! Your house must be full of fun! Did you always want a big family?"

Us proud mums will probably answer willingly all the above as we chat about our kids, but this question was the correct one to ask.

Personally, we are Byzantine Catholic and my husband is training to be a priest and yes we did always want a big family, and I'm happy to tell you that. But 'Are you done?'.... that's an immediate judgement and I suddenly feel like as you check my cervix I have to justify my entire life, my religion and my sanity.

Please take a moment when encountering a big family to think about your words.

Just because this is our 6th or 10th baby, doesn't mean we aren't every bit as delighted and excited as if it was our first baby. Whether you agree or not, we come for support. Not to be shamed.

Thank you for listening if you made it this far :)'

I personally don’t believe any midwife will mean to be unkind but in our society, we tend to comment on mothers and their choices. Especially if there’s something unusual about them.

Seeing things from a woman’s point of view amidst busy practice and the rocky terrain of trying to keep humour and connection front and center is hard.

I think Rosie’s post contains valuable insight. Especially about the healthcare assistant with the kind and thoughtful comment, this is a great example of being with woman, understanding what it must be like to lead her life and talking with her accordingly.

As Rosie says, thanks so much for reading this!

And thanks to Rosie for writing it, it's brave and how gorgeous is her family?!

Do you have anything to add – have you cared for a woman with a big family? How did you talk about it? Or are you from a big family, is there anything else we should know?

You know those books that you read and feel yourself being changed? I think it's called 'internalisation'.

This is one of those. Especially if you're white.

Reni Eddo-Lodge is a journalist and author who wrote the book 'Why I’m No Longer Talking to White People About Race'.

Her work focuses on racism and feminism. I think it's the exhaustion in her tone that gets me.

Did you know:

A slogan put about by the Conservative government was 'if you want a n**** as your neighbour, vote labour' - this was 1985

Children of colour get marked down in school

But when their work is assessed independently under a white British sounding name, they get the grades they deserve

Bristol was a slave port and the UK has a lot of its wealth from black slavery

Black and ethnic minority women are three times more likely to die during childbearing.

It's a hard one. If you're white, you might be thinking 'well I'm not racist'.

I believe you. But we live in a society that's got racism baked into it. Not our fault. Still our responsibility.

Reverse racism hits the news sometimes. White people being at a disadvantage because people from a black or ethnic minority group are discriminating against them.

The problem is that reverse racism doesn't happen in a way that takes meaningful power away from white people.

White people might find themselves in a single situation - say working for an ethnic minority family who pass them over for a promotion in favour of someone from their own background - but that white person will have more many opportunities over the course of their lifetime based on their ethnicity.

Ethnic minority groups literally do not have enough people in positions of power to even begin to level the playing field.

I think it's so important for midwives and students to be aware of the tension and inequality that black and ethnic minority people face.

I'm not saying white people don't have adversity or don't work hard. I had my first job at age 12 and I've worked ever since then. My family was often financially insecure when me and my siblings were growing up. I've faced sexism as well, in a workplace that still thought the men were more likely to be correct than the women.

It's just that there's a huge bias that black and ethnic minority people have to fight against all the time. You can't really fight against sexism without understanding racism. You miss so much of the picture.

The problem is to understand race as a white person, you need to put your own way of seeing the world on hold. This is pretty much impossible. The only way to do it is to think of a time when you've been so frustrated that someone couldn't see the inequality in a situation.

For instance, many women will have had a conversation with someone who doesn't see the point of International Women's Day as there's no International Men's Day.

I've been in a situation where I've been frustrated to tears trying to get a guy to understand why International Women's Day is important.

The risk of FGM, pay differences, the tension women face balancing having children and a career etc. It falls on deaf ears. It's like it doesn't even exist.

This is what black and ethnic minority people are trying to tell us. There's a whole existence in parallel with ours as white people. We're blind to it.

It's not for me to tell anyone what to do but I'd encourage you to read Reni Eddo-Lodge's book, listen to her podcast, or listen to Sprogcast, the episode with Doula Mars Lord.

Listening and understanding is only fair.

But also, if like me, the best bit of midwifery or caring for others is the privilege of understanding their stories: there is so much more to learn.

So many more ways of existing in the world to get to know.

I find this exciting.

Now I'd love to hear from you.

Please comment, especially if you're from a black or minority ethnic group, especially if you think I've left anything out!

Or if you're white - do you already know this?

Much Love,

p.s. I don't feel wise enough to write this. But I have a platform and I'm white. Even if I get it wrong I need to be trying. Feel free to correct me and please know - if I have made mistakes or caused offence, this is due to my ignorance, not malice. I'll keep learning, I'm sorry I and others haven't noticed in a meaningful way until now and I'm LISTENING.

Isn’t it amazing how sometimes those with the hardest path in life can be the most upbeat?

I was not at all experienced when I first cared for a family whose baby had died.

I can remember crying my eyes out in the middle of labour ward because it was just too painful. Luckily, I had an amazing manager who gave me continuity with the family in question and I was able to follow them for 3 days worth of shifts. Their little boy had been stillborn after a complicated labour.

Did you know I'm the middle of the final edit for my midwifery novel?

I'm beyond excited about it of course. But in a way, I don't want to finish the work and leave this world I'm living in. My early morning writing sessions hanging out with my main character, Chloe the student midwife, are the best thing about life at the moment.

At the beginning of January 2018, I thought about all the inspirational birth world people I’m in contact with.

I'll be honest - writing my second midwifery novel isn't going well today. But instead of having a self-induced meltdown, I'm sat here writing this with a liquorice, fennel, thyme and orange peel blend tea. This has been inspired by today's interview with independent midwife Joy Horner (and replaces my 'rocket fuel' coffee that I usually have, so is a bigger deal than it might sound). It helps no end to realise there are wise women like Joy out there. I bet you'll find her just as uplifting as I do.(more…)

Here I am at Kingston and St Georges midwifery conference, 2018. Today there will be ten talks and events exploring the concept 'I Have a Voice' and I’ll be reporting on each of them in ‘Notes of Midwifery Voices’.